Special partnerships

A friend of mine recently told me that the road signs used throughout Great Britain were devised by a partnership between Richard Kinneir and Margaret Calvert. Their system has become a model for modern road signage. This led me on to think of other great partnerships such as husband and wife, Steven and Hilary Rose. Steven Rose is a neuroscientist and biologist and Hilary Rose, a sociologist. Their writings have had significant influence on me.

Another married couple, who individually and together have had an influence on me, are Prof Sir Simon Wessely, former President of the Royal College of Psychiatrists, and his wife Dr Clare Gerada, former President of the Royal College of General Practitioners.

Yesterday, Dr Gerada was one of the guests on radio 4, where she was debating with Professor John Read on the subject of antidepressants. This follows a recent meta-analysis on antidepressants published in the Lancet which gained wide media attention alongside headlines that “millions more sufferers” should now be prescribed antidepressants. What was not made clear however is that the meta-analysis considered studies of an average of only 8 weeks and that side-effects were not considered.

In the Radio 4 broadcast Dr Gerada was emphatic about the benefits of antidepressants and stated her view “that the vast of majority of patients who come off antidepressants have no problem whatsoever coming off them”. Dr Gerada made no mention that long term or indefinite treatment is the most common outcome for the 1  in 9 (in England and Wales) and 1 in 7 (in Scotland) taking antidepressants. This despite the fact that we have a dearth of evidence to inform such prescribing.

Following the Radio 4 broadcast, Professor Wessely described  those who voiced harmful experiences with antidepressants as “pill shaming”. I was disappointed in such use of language, as, apart from being uncaring, it also likely to stifle opportunities to learn from the experience of those taking antidepressants. Without listening to such experience it is most unlikely that we can optimise prescribing.

It is my view that professionals need to consider the consequences of over-simplistic divides. Here the debate on antidepressants has been an example. Professionals need to give equal weight to the potential for benefits as well as to the potential for harms. In this case, we have only evidence for short-term use and so advocating increasing use of antidepressants without acknowledging that most of the population are taking antidepressants in the long term, is not realistic medicine.

Returning to where I started, with the partnership between Richard Kinneir and Margaret Calvert and their system for modern road signage: imagine that their signs were reduced to just two: “North Pole this way” and “South Pole that way”. We would get lost without all the important middle ground in-between.

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